If you’re researching Medicare, it’s no surprise that you see nothing but Medicare Advantage everywhere you look. From sponsored ads to mailed advertisements, endless phone calls, and TV and radio commercials, it never ends.
So what is Medicare Advantage and is it really an advantage to you?
Let’s find out…
- What is Medicare Advantage?
- What does Medicare Advantage come with?
- What are the types of Medicare Advantage plans
- Pros & Cons of Medicare Advantage
- What does Medicare Advantage cost?
- Things to consider before getting Medicare Advantage
- Who can help me make the RIGHT Medicare decision?
What is Medicare Advantage?
There are two main paths you can choose between when joining Medicare: Original Medicare and Medicare Advantage.
Get more information on Original Medicare.
Medicare Advantage is also known as Medicare Part C. Medicare Advantage plans are offered by private insurance companies like United Health Care, Kaiser Permanente, and Aetna.
You must have Medicare Part A and Medicare Part B in order to enroll in an Advantage plan.
These plans are highly advertised because they make insurance companies and agents the most money. We will get into that in a little bit.
What does Medicare Advantage come with?
These plans are normally advertised to come with perks and benefits for “free”.
Advantage plans combine both Medicare Part A and Medicare Part B. They can also include:
- Medicare Part D prescription drug coverage
- Gap coverage (20% that Part A and Part B do not cover)
- Dental & Vision coverage
- Hearing & hearing aides
- Fitness memberships
- Meal delivery services
Depending on the plan and the location, the added benefits vary.
Types of Medicare Advantage plans
There are varying types of Advantage plans available to you, there are two main types:
Health Maintenance Organization (HMO) – In most HMOs, you can only go to doctors, other health care providers, or hospitals in the plan’s network, except in an urgent or emergency situation. You may also need to get a referral from your primary care doctor for tests or to see other doctors or specialists.
Preferred Provider Organization (PPO) – In a PPO, you pay less if you use doctors, hospitals, and other healthcare providers that belong to the plan’s network. You usually pay more if you use doctors, hospitals, and providers outside of the network.
The other two types are Private Fee-for-Service (PFFS) and Special Needs Plans (SNPs).
Medicare Advantage Costs
Advantage plans have varying costs based on location and companies, but to get an overview here is what you could expect to pay:
- Plan monthly premiums
- Medicare Part B premium ($174.70 a month for most people)
- Co-payments for all appointments
- Out-of-pocket maximums ($8,850 in 2024)
Advertisements for these plans can be misleading as they say they are “free” or low cost. The truth is, we all pay for our health care one way or the other.
Pros & Cons of Medicare Advantage
While each person’s situation is different, there are many things to consider when looking at an Advantage plan. Here are some things to consider:
PROS:
- Advantage plans tend to have lower monthly premiums.
- There are additional perks for many Advantage plans.
CONS:
- For coverage to apply, you have to see doctors within the Advantage plan networks.
- Advantage plans are annual plans. Plans may decide not to negotiate or renew their contracts.
- Plans can change every year including deductible, monthly premiums, and copay amounts.
- Annual out-of-pocket costs are normally higher than Original Medicare.
- You may have to get approvals and referrals for certain procedures and appointments.
Things to consider before getting Medicare Advantage
When deciding between Advantage and Original Medicare, we recommend these things:
- What doctors do you want to see when you’re on Medicare (now and in the future)
- Where do you live
- Do you plan on moving states
- Do you plan on travelling abroad
- What medications do you take
These are just some of the important factors to take into account when making your Medicare decision. Advantage can save you money month to month, but become costly when you need them the most.
Far too often we hear horror stories of people who were sold Advantage plans that were not right for them and are now faced with thousands of dollars of medical bills they can’t afford.
If you need help finding the right path for you, be sure you find someone who has your best interest.
Who can help me make the RIGHT Medicare decision?
Advantage plans can work for certain people, but for most, it doesn’t.
At the Medicare Coach, we help our clients compare both Medicare paths to help them pick the best path that fits them now and in the future.
The Medicare Coach is an independent expert. We are not associated with an insurance company, agent, or broker making our advice completely unbiased.
To get help with your decision, you can register for my next free online workshop by going here: https://join.themedicarecoach.com/free-workshop
